İyatrojenik Böbrek Kanamalarında Transarteriyel Embolizasyonun Rolü: Klinik Sonuçlar ve Böbrek Fonksiyonunun İzlemi – Bir Kohort Çalışması

Öz

ÖZ Amaç: İyatrojenik renal hemorajisi olan hastalarda transarteriyel embolizasyonun klinik etkinliğini ve işlem sonrası hemoglobin düzeyleri ile glomerüler filtrasyon hızındaki (GFR) değişimi değerlendirmek. Gereç ve Yöntemler: İyatrojenik renal hemoraji nedeniyle embolizasyon uygulanan 38 hastanın geriye dönük analizi yapıldı. Embolik ajan olarak koil, PVA ve kombinasyonlar kullanıldı. İşlem öncesi ve sonrası hemoglobin düzeyleri ile 1., 6. ve 12. aylardaki GFR değerleri karşılaştırıldı. Bulgular: Kanamaya yol açan işlem sonrası hemoglobin düzeylerinde istatistiksel olarak anlamlı azalma saptandı (p < 0.001). Bir hasta dışında embolizasyon sonrası hastaların tümünde hemoglobin düşüşü durdu. Bir hastaya ikinci seans embolizasyon uygulandı. GFR değerlerinde zamanla hafif ancak istatistiksel olarak anlamlı olmayan bir düşüş gözlendi. Kullanılan embolik ajan türü renal fonksiyon üzerinde anlamlı bir farklılık yaratmadı. Majör komplikasyona rastlanmadı.

Anahtar Kelimeler

• Renal kanama
• embolizasyon
• GFR
• hemoglobin
• iyatrojenik
• girişimsel radyoloji.

The Role of Transarterial Embolization in Iatrogenic Renal Hemorrhage: Clinical Outcomes and Renal Function Monitoring – A Cohort Study

Abstract

ABSTRACT Objective: To evaluate the clinical efficacy of transarterial embolization in patients with iatrogenic renal hemorrhage and its effects on hemoglobin levels and glomerular filtration rate (GFR) over time. Materials and Methods: A retrospective analysis was conducted on 38 patients who underwent embolization for iatrogenic renal hemorrhage. Various embolic agents including coil, PVA, and a combination were used. Hemoglobin values before and after the procedure, and GFR values at 1st, 6th, and 12th months were compared. Results: There was a statistically significant decrease in hemoglobin levels after the procedure that caused bleeding (p < 0.001). The GFR values showed a mild but not statistically significant decrease over time. Embolic agent type did not significantly impact renal function outcomes. No major complications were observed. Conclusion: Transarterial embolization is an effective and safe method for managing iatrogenic renal hemorrhages, with minimal impact on long-term renal function.

Keywords

• Renal hemorrhage
• embolization
• GFR
• hemoglobin
• iatrogenic
• interventional radiology.

Kaynakça

1. 1. Ramaswamy RS, Akinwande O, Tiwari T. Renal Embolization: Current Recommendations and Rationale for Clinical Practice. Curr Urol Rep 2018; 19(3):5.
2. 2. Ganpule AP, Shah DH, Desai MR. Postpercutaneous nephrolithotomy bleeding: aetiology and management. Curr Opin Urol 2014; 24(2):189-94.
3. 3. Rossi M, Krokidis M, Kashef E, Peynircioglu B, Tipaldi MA. CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms. Cardiovasc Intervent Radiol 2024; 47(1):26-35.
4. 4. Grange R, Magand N, Lutz N, Lanoiselee J, Leroy S, Boutet C, Grange S. Clinical outcomes after emergency transarterial renal embolization: a retrospective study. CVIR Endovasc 2024; 7(1):88.
5. 5. Muller A, Rouvière O. Renal artery embolization-indications, technical approaches and outcomes. Nat Rev Nephrol 2015; 11(5):288-301.
6. 6. Feng Y, Zhang X, Zhao R, An X. Super-selective renal artery embolization (SRAE) for iatrogenic and traumatic renal hemorrhage. BMC Surg 2024; 24(1):282.
7. 7. Baerlocher MO, Nikolic B, Sze DY. Adverse event classification: clarification and validation of the society of interventional radiology specialty-specific system. J Vasc Interv Radiol 2023; 34:1–3.
8. 8. Poulakis V, Ferakis N, Becht E, Deliveliotis C, Duex M. Treatment of renal-vascular injury by transcatheter embolization: immediate and long-term effects on renal function. J Endourol 2006; 20(6):405-9.

9. 9. Ginat DT, Saad WE, Turba UC. Transcatheter renal artery embolization: clinical applications and techniques. Tech Vasc Interv Radiol 2009; 12(4):224-39.
10. 10. Sauk S, Zuckerman DA. Renal artery embolization. Semin Intervent Radiol 2011; 28(4):396-406.
11. 11. Luciano RL, Moeckel GW. Update on the Native Kidney Biopsy: Core Curriculum 2019. Am J Kidney Dis 2019; 73(3):404-15.